DOI QR코드

DOI QR Code

Socioeconomic Equity in Regional Distribution of Health Care Resources in Korea

지역의 경제수준에 따른 의료자원 분포의 형평성 분석

  • Jeon, Bo-Young (Graduate School of Public Health, Seoul National University) ;
  • Choi, Su-Min (Graduate School of Public Health, Seoul National University) ;
  • Kim, Chang-Yup (Graduate School of Public Health, Seoul National University)
  • Received : 2011.09.30
  • Accepted : 2012.02.06
  • Published : 2012.03.31

Abstract

One of the ways to achieve the principle of equal access for equal needs, availability and geographical accessibility of health care resources regardless of resident sites is important. The purpose of this paper is to measure socioeconomic inequities in distribution of health care resources among regions in the Republic of Korea (hereafter Korea). Data were extracted from regional statistics of National Health Insurance, Community Health Survey, Korea Social Science Data Archive, and Korean Statistical Information Services at the same period of 2009. The dependent variables were the number of health workforce and health care facilities in each region. The proxy indicator of regional socioeconomic status was local tax per person. To identify whether inequalities among regions, we examined the concentration index(CI) and indirectly standardized CI by controlling each region's demographics and need factors. Total observations were 232 districts in nationwide, and we analyzed separately Seoul(25 districts) and non-Seoul areas(207 districts). The standardized CI values of health care resources were positive(favoring the rich region) across the nation in almost all kinds of resources. Especially the number of specialist, dentist, dental clinics, clinics, oriental medical clinics, pharmacists, and pharmacies were statistically significantly favoring the rich region. But the CI for the number of long-term care hospitals, public health centers were negative(favoring the poor region). The tendency of CI presenting positive values were increased in Seoul area. But in the case of non-Seoul, the CI indexes were nearly zero. The results suggest that except the Seoul area, little regional socioeconomic-related inequalities were observed in the distribution of health care resources in Korea.

Keywords

References

  1. 국민건강보험공단 보도자료."보건의료인력 지역별로 큰 차이 보여": 2010. 12. 30.
  2. 국민건강보험공단. 지역별 의료이용통계: 2009.
  3. 국가통계포털. 시군구 지방세 자료. 행정안전부: 2009.
  4. 강암구. 지역간 보건의료자원 분포에 따른 의료이용의 형평성. 사회보장연구 2007; 23(2): 189-219.
  5. 김수진, 고영, 오주환, 권순만. 건강보험 암 중증질환 급여확대가 의료이용 형평성에 미친 영향. 보건행정학회지 2008; 18(3): 90-109. https://doi.org/10.4332/kjhpa.2008.18.3.090
  6. 박보람. 장기요양시설 분포에 영향 미치는 지역적 특성에 관한 연구[석사학위 논문]. 서울: 서울대학교 보건대학원; 2009.
  7. 박수경. 병상자원의 효율적 관리 방안. HIRA 정책동향 2011; 5(6): 21-27.
  8. 보건복지부. 보건의료기본법 법률 제9847호 제1장 제4조. 시행 2010.12.30.
  9. 신호성, 이수형. 공간분석을 이용한 외래의료서비스 접근성 요인분석. 보건행정학회지 2011; 21(1): 23-43. https://doi.org/10.4332/kjhpa.2011.21.1.023
  10. 오영호, 조재국, 최병호, 이신호, 이상영, 박재용 등. 의료공급 중장기 추계. 한국보건사회연구원: 2006.
  11. 오영호, 신호성, 이상영, 김진현. 보건의료인력자원의 지역별 분포의 적정성과 정책과제. 한국보건사회연구원: 2007.
  12. 오영호. GINI계수에 의한 주요 보건의료인력의 지역간 분포 변화. 보건복지포럼 2008.5; 98-110.
  13. 오영호. 의료인력 수급의 문제점과 개선방안. HIRA 정책동향 2011; 5(6): 12-20.
  14. 이용재. 지역특성이 보건의료자원 분포의 불평등에 미치는 영향. 상황과 복지 2005; 21: 49-78
  15. 이용재. 지역간 건강보험이용의 형평성 분석. 한국사회정책 2008; 15(1): 5-38.
  16. 임국환, 이준협. 의료기관 종별 소득계층간 의료이용 불평등. 보건경제와 정책연구 2010; 6(2): 39-56.
  17. 의료법. 법률 제10785호 제1장 제2조(의료인) 및 제3조(의료기관). 시행 2011.12.8.
  18. 장동민. 의료서비스 분배의 형평성. 보건과 사회과학 1997; 2: 23-56.
  19. 질병관리본부. 2009년 지역건강통계 한눈에 보기: 2010.
  20. 통계청 e-나라지표. 지표명: 지역내총생산(GRDP). 출처: 지역소득통계팀. 최근 갱신일: 2011a-12-27.
  21. 통계청 e-나라지표. 지표명: 지방자치단체의 재정자립도. 출처: 행정안전부, 재정정책과, 최근 갱신일: 2011b-07-04
  22. 통계청 e-나라지표. 지표명: 지방세 현황. 출처: 행정안전부, 지방세분석과, 최근 갱신일: 2011c-12-23
  23. 채수미, 김창엽, 고수경. 외래내원 천식환자의 사회경제적 상태에 따른 의료이용의 형평성. 보건과 사회과학 2007; 22: 183-203.
  24. 최병호, 노연홍, 윤병식, 신현웅, 김명희, 김창엽. 국민의료의 형평성 분석과 정책과제. 한국보건사회연구원 연구보고서: 2004.
  25. 하능식, 임성일. 지역의 인구구조가 지방재정에 미치는 영향. 한국지방재정학회 2007; 12(1): 77-98.
  26. 한국건강형평성학회. 건강형평성 측정 방법론. 파주: 한울; 2008.
  27. 한국사회과학자료원. KOSSDA 시.군.구 통계 2008, 2009: 2010.
  28. 황라일, 서수라, 김진수, 최인덕, 문성웅, 윤석준 등. 공공과 민간의료기관의 의료서비스 공공성 평가 연구. 국민건강보험공단: 2008.
  29. Anand S, Fan VY, Zhang J, Zhang L, Ke Y, Dong Z et al. China's human resources for health: quantity, quality, and distribution. Lancet. 2008; 15; 372: 1774-1781.
  30. Bodenheimer, Grumbach. Understanding Health Policy: A clinical approach. New York: McGraw-Hill Medical; 2009. pp. 17-30.
  31. Buchan J., Calman L. Skill-mix and policy change in the health workforce: Nurses in advanced roles. OECD HEALTH WORKING PAPERS NO. 17. 2004.
  32. Butler DC, Petterson S, Bazemore A, Douglas KA. Use of measures of socioeconomic deprivation in planning primary health care workforce and defining health care need in Australia. Aust J Rural Health. 2010; 18(5): 199-204. https://doi.org/10.1111/j.1440-1584.2010.01154.x
  33. Chambers N. Markets and choice in health care. In: Mahon A., Walshe K., Chambers N., editors. A reader in health policy and management. Berkshire: McGraw-Hill Open University Press; 2009. p. 122.
  34. Gravelle F. Measuring income related inequality in health: standardization and the partial concentration index. Health Economics, 2003; 12: 803-819.
  35. Hart JT. The inverse care law. Lancet 1971; 1: 405-12. https://doi.org/10.1016/S0140-6736(02)95376-6
  36. Hennell T. Resource allocation policies to reduce avoidable health inequalities between Primary Care Trusts in England. Eurohealth 2009; 15(3): 22-24
  37. Kakwani N., Wagstaff, A., van Doorslaer E. Socioeconomic inequalities in health: Measurement, computation, and statistical inference. Journal of Economics 1997; 77: 87-103. https://doi.org/10.1016/S0304-4076(96)01807-6
  38. Kreng VB., Yang C-T. The equality of resource allocation in health care under the National Health Insurance System in Taiwan. Health Policy 2011; 100: 203-210. https://doi.org/10.1016/j.healthpol.2010.08.003
  39. Lee J., Park S., Choi K., Kwon S. The association between the supply of primary care physicians and population health outcomes in Korea. Fam Med 2010 Oct; 42(9): 628-35.
  40. Liu Y., Hsiao W., Eggleston K. Equity in health and health care: the Chinese experience. Social Science & Medicine 1999; 49: 1349-1356. https://doi.org/10.1016/S0277-9536(99)00207-5
  41. Matsumoto M, Inoue K, Farmer J, Inada H, Kajii E. Geographic distribution of primary care physicians in Japan and Britain. Health Place. 2010; 16(1): 164-166. https://doi.org/10.1016/j.healthplace.2009.07.005
  42. Matsumoto M, Inoue K, Bowman R, Noguchi S, Toyokawa S, Kajii E. Geographical distributions of physicians in Japan and US: Impact of healthcare system on physician dispersal pattern. Health Policy. 2010; 96(3): 255-261. https://doi.org/10.1016/j.healthpol.2010.02.012
  43. Mooney GH. Equity in health care: confronting the confusion. Eff Health Care 1983 Dec; 1(4): 179-85.
  44. O'Donnell O., van Doorslaer E., Wagstaff A., Lindelow M. Analyzing Health Equity Using Household Survey Data: A guide to techniques and their implementation. The World Bank: Washington, D.C. 2007.
  45. Oliver A.J., Mossialos E. Equity of access to health care: outlining the foundations for action [online]. London: LSE Research Online. 2004.
  46. Rice N., Smith P.C. Ethics and geographical equity in health care. Journal of Medical Ethics 2001; 27: 256-261. https://doi.org/10.1136/jme.27.4.256
  47. Roemer M.I. National health systems of the world: The countries (Vol. 1). New York: Oxford University Press: 1991.
  48. Rundall T.G., McClain J.O. Environmental selection and physician supply. American Journal of Sociology 1982; 87(5): 1090-1112. https://doi.org/10.1086/227556
  49. Steele R. Marginal met need and geographical equity in health care. Scottish Journal of Political Economy 1981; 28(2): 186-195.
  50. Simoens S., Villeneuve M., Hurst J. Tackling Nurse Shortages in OECD Countries. OECD Health Working Papers NO. 19. 2005.
  51. Wagstaff A., Van Doorelaer E., Paci P. On the measurement of horizontal inequity in the delivery of health care. Journal of Health Economics 1991; 10: 169-205. https://doi.org/10.1016/0167-6296(91)90003-6

Cited by

  1. Thoracic and Cardiovascular Surgeons’ Perception of the Concentration of Cardiovascular Operations in Seoul Metropolitan Area’s Hospitals vol.49, pp.S1, 2016, https://doi.org/10.5090/kjtcs.2016.49.S1.S53